Provider Demographics
NPI:1588463970
Name:PEGGY, MEKEMASHA
Entity type:Individual
Prefix:
First Name:MEKEMASHA
Middle Name:
Last Name:PEGGY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 GOLF COURSE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2330
Mailing Address - Country:US
Mailing Address - Phone:227-243-1908
Mailing Address - Fax:
Practice Address - Street 1:4401 CLERMONT DR NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4952
Practice Address - Country:US
Practice Address - Phone:202-445-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant